Pleural Effusion

(Water on the Lungs)
  • Definition

    The pleura are two thin, moist membranes around the lungs. The inner layer is attached to the lungs. The outer layer is attached to the ribs. Pleural effusion is the buildup of excess fluid in the space between the pleura. The fluid can prevent the lungs from fully opening. This can make it difficult to catch your breath.
    Pleural effusion may be watery (transudative) or thick (exudative) based on the cause. Treatment of pleural effusion depends on the condition causing the effusion.
    Pleural Effusion
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  • Causes

    Effusion is usually caused by disease or injury.
    Transudative effusion may be caused by:
    Exudative effusion may be caused by:
    • Tuberculosis
    • Pneumonia and other lung infections
    • Rheumatic disease, such as sarcoidosis
    • Anti-inflammatory diseases, such as Lupus
    • Cancer, especially of the lung, breast, or lymph system
    • Blood clot formation in the lung
  • Risk Factors

    Factors that increase your chance of getting pleural effusion include:
    • Having conditions or diseases listed above
    • Certain medications such as:
      • Nitrofurantoin
      • Methysergide
      • Bromocriptine
      • Procarbazine
      • Amiodarone
    • Chest injury or trauma
    • Radiation therapy
    • Surgery, especially involving:
      • Heart
      • Lungs
      • Abdomen
      • Organ transplantation
  • Symptoms

    Some types of pleural effusion do not cause symptoms. Others cause a variety of symptoms, including:
    • Shortness of breath
    • Chest pain
    • Stomach discomfort
    • Cough
    • Coughing up blood
    • Shallow breathing
    • Rapid pulse or breathing rate
    • Weight loss
    • Fever, chills, or sweating
    • Hiccupping
    These symptoms may be caused by many other conditions. Let your doctor know if you have any of these symptoms.
  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. This may include listening to or tapping on your chest. Lung function tests will test your ability to move air in and out of your lungs.
    Some blood tests will be done based on what the doctor thinks it causing the fluid.
    Images of your lungs may be taken with:
    Your doctor may take samples of the fluid or pleura tissue for testing. This may be done with:
  • Treatment

    Treatment is usually aimed at treating the underlying cause. This may include medications or surgery.
    Your doctor may take a "watchful waiting" approach if your symptoms are minor. You will be monitored until the effusion is gone.
    To Support Breathing
    If you are having trouble breathing, your doctor may recommend:
    • Breathing treatments—inhaling medication directly to lungs
    • Oxygen therapy
    Drain the Pleural Effusion
    The pleural effusion may be drained by:
    • Therapeutic thoracentesis—a needle is inserted into the area to withdraw excess fluid.
    • Tube thoracostomy—a tube is placed in the side of your chest to allow fluid to drain. It will be left in place for several days.
    Seal the Pleural Layers
    The doctor may recommend chemical pleurodesis. During this procedure, talc powder or an irritating chemical is injected into the pleural space. This will permanently seal the two layers of the pleura together. The seal may help prevent further fluid buildup.
    Radiation therapy may also be used to seal the pleura.
    Surgery
    In severe cases, surgery may be needed. Some of the pleura will be removed during surgery. Suregery options may include:
    • Thoracotomy—traditional, open chest procedure
    • Video-assisted thorascopic surgery (VATS)—minimally-invasive surgery that only requires small keyhole size incisions
  • Prevention

    Prompt treatment for any condition that may lead to effusion is the best way to prevent pleural effusion.
  • RESOURCES

    American Lung Association http://www.lung.org

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

    CANADIAN RESOURCES

    The Canadian Lung Association http://www.lung.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Drug-induced pulmonary disease. Merck Manual for Health Care Professionals. Available at: http://www.merckmanuals.com/professional/pulmonary%5Fdisorders/interstitial%5Flung%5Fdiseases/drug-induced%5Fpulmonary%5Fdisease.html . Updated May 2008. Accessed March 3, 2013.

    Pleural effusion. Remedy's Health Communities website. Available at: http://www.healthcommunities.com/pleural-effusion/overview-of-pleural-effusion.shtml . Updated June 1, 2000. Accessed March 5, 2013.

    Pleural effusion-diagnostic evaluation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what . Updated December 8, 2012. Accessed February 24, 2013.Pleural effusion - differential diagnosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what . Updated December 8, 2012. Accessed February 24, 2013

    Pleurisy and other pleural disorders. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/pleurisy/ . Updated September 21, 2011. Accessed March 5, 2013.

    12/10/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Roberts M, Neville E, Berrisford R, Atunes G, Ali N. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax . 2010;65 Suppl 2:ii32.

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